Clinical Efficacy of Corticosteroids in the Early Stages of Deterioration in COVID-19 Pneumonia

Figures & data

Table 1 Clinical Course of Patient on Admission

Day of illness	3	4	5	6	7	8	9	10	11	12	13	14	15	16
Day of hospitalization	1	2	3	4	5	6	7	8	9	10	11	12	13	14
Temperature (^oC)	37.0	38.6	39.0	36.8	37	36.8	37.0	36.5	36.0	36.4	36.0	36.4	36.4	36.5
Neutrophil count (10^9/L)	3.96			6.40	5.74	6.48	4.74	5.74		12.0	8.35	7.88	6.53
Lymphocyte count (10^9/L)	1.12			0.59	0.71	0.48	0.59	0.94		1.13	0.55	1.12	1.10
Glutamic oxalacetic transaminase (U/L)	21			29		22		36		38	42		41	44
Albumin (g/L)	40.7			35		33.1		35.9		34.4	32.7		32.1	32.5
Fasting plasma glucose (mmol/L)	11.28			20.19		15.46		8.45		9.8	14.2		10.6	10.7
C-reactive protein (mg/L)	75.60					25.1				5	6.4		8.30	5
Creatinine (μmol/L)	41.6			60.3		63.3		38		36.9	32.2		31.3	33.4
Procalcitonin (μg/L)	0.1			0.16		0.19		0.15		0.10	0.10		0.10	0.13
Lactate dehydrogenase (U/L)	357			410		408		364		363	337		305
NT-proBNP (pg/ml)				303.4		218.8							122.9
D-dinner (ng/ml)				0.3		10	10		4.2	3.5	3.9			2.7
Oxygen supplementation	2L	5L	65%	80%	100%	60%	50%	45%	40%	40%	32%	32%	32%	32%
Mode of ventilation			High flow 60 L/min		Volume control		Pressure support		High flow 45 L/min		High flow 35 L/min
Tide volume (ml)					450	450
Pressure support (cmH2O)							20	15	12
Plateau pressure (cmH2O)					23	20
PEEP (cmH2O)					10	10	10	8	5
Pao2/Fio2 ratio	189	143	132	96	104	208	254	337	462	252	331	531
Propofol (mg/hour)					30	30	30	40	10
Midazuolun (ml/h)					4	3	3	6	3
Morphine (mg/h)					3	2	1
Fentanyl (ug/kg/h)								0.32	0.24
Glasgow Coma Scale					Paralyzed	E2VTM4		E4VTM6		E4VTM6			E4V5M6
SARS CoV-2 RT-PCR (throat swab)						Eyes open and motor withdrawal in response		Eyes open spontaneously obeys commands for movement					Eyes open spontaneously Oriented and obeys commands for movement
Antimicrobial therapy	Positive	Positive										Negative	Negative
Methylprednisolone (mg/d)	lopinavir/ritonavir				Arbidol		Arbidol		Arbidol			Arbidol
24 hours fluid balance (ml)		40			40	40	40	40
(Total input-total output)	620	200	-1350	-1060	1030	-182	50	-309	-880	-325	160	860	-60	120

Abbreviations: COVID-19, coronavirus disease 2019; CT, computed tomography; FiO2, fraction of inspired oxygen; PaO2, partial pressure of oxygen; PEEP, positive end –expiratory pressure; RT-PCR, reverse transcriptase-polymerase chain reaction; SARS-CoV2, severe acute respiratory syndrome coronavirus 2.

Figure 1 Chest CT images of a 52-year-old woman with COVID-19 pneumonia. Chest CT images (A1 and A2) show patchy ground glass opacities with alveolar consolidation in dependent segments of both lungs with an asymmetric distribution. Three days later, CT images (B1 and B2) revealed a marked increase in lesions. CT images (C1 and C2) on day eight, after five days of corticosteroid use, showed a significant decrease in lesions. CT images (D1 and D2), after six months of follow-up, are normal.